Cup Feeding Strikes Again!

[TiffyRN, BSN, PhD]

So I had this lovely little guy, about 3700 grams, term, some meconium staining at birth, otherwise completely boring pregnancy and lady partsl delivery. He had some low blood sugars (which we call chemstrips or chems where I work), so they followed their protocal (the chem was still like in the 40's) and put the baby to breast and rechecked, well, turns out the average woman cannot really produce enough milk at hours after birth to raise that kind of blood sugar (sarcasm intended). So they followed their protocol and gave him formula, by cup, because we don't want nipple confusion. Problem is you can only really cup feed so much so he was getting about 20-30mls per feed.

I can understand this if it's like a one time event and gets the kid over the hump, but he had recurring low chems and when he finally dipped under 35 he bought himself a gavage feed and an admission to NICU. Of course we NICU folks aren't quite as concerned about nipple confusion as we are about say; brain damage so we proceeded to bottle feed the kid. So his lowest blood sugar during his entire admission was 63. He wolfs down 60-90 mls of either formula or breastmilk (turns out his mom's milk came in pretty early and abundant). We have had several admissions to our unit that could have been prevented had our General Nursery been permitted to use a bottle (cup feeding only used for babies that moms state want to breastfeed).

So to prevent the threat of nipple confusion this kid had to spend hours separated from his mother until we established that his blood sugars were stable whereupon we started having her breastfeed followed by a pc bottle. He will be going home a day late due to this silliness.

I am so frustrated with cup feeding !!!!!! We are getting frequent admissions of kids who develop tachypnea or resp distress after cup feeding (can you say aspiration?). I know I've ranted about this before, but here I go again.

[doularoz]

We have the same issue only our alternate method of feeding is "finger feeding". Basically you put a 5F ng tube attached to a syringe full of formula into the baby's mouth with your finger. Then squirt the milk into the kids mouth and hope he is able to swallow it. We have had admissions for low chem strips because of the anti bottle law. It's sad because the postpartum has these mothers set up for disapointment when we insist on bottle feeding. Then we're the bad guys.

[Elvish, BSN, DNP, RN, NP]

I work postpartum and I totally agree w/ you guys. Even though I have never seen a baby have resp. issues after cup feeding, I hate it. 1) It is a pain in the butt. 2) I don't think nipple confusion actually exists, esp. not if baby is BFing well. Our management won't let us bottlefeed a breast baby unless mom specifically asks. I am with you on the rant. I have nothing against lactation consultants per se, but we have several at our hospital that are like the Nipple Gestapo. Most of my Hispanic mothers breast and bottle their kids with absolutely no problem. Hate cupping!!!

[BittyBabyGrower, MSN, RN]

We do not cup feed in our nursery or in the NICU....it's either bottle or gavage. Fingerfeeding...you really arent' supposed to squirt it in, the theory behind that is that the baby should suck hard enough to draw the plunger down on the syringe...well, gee,if he could do that then he should be able to BF. And finger feeding....I wouldn't want some glove in my kid's mouth that comes out of one of those boxes...who knows whose dirty hand has been in there with what on it...ewwwwww.

[TiffyRN, BSN, PhD]

We just started the cup feeding thing (as in General Nursery started it, not NICU, there is no cup feeding in the NICU). It's part of the hospital's effort to be designated a "Baby Friendly" hospital. Apparently we are applying for that status.

[navyscrubs]

I don't know what the deal with cup feeding is. I've never heard of it. When I had my son and I was having trouble breastfeeding him my breastfeeding consultant gave me syringe to feed him with. I pumped everyday and gave two to three syringes every two hours till he started breastfeeding well. I don't know why the people in your nursery wouldn't have thought of something as simple as that.

Sharly

[navyscrubs]

I work postpartum and I totally agree w/ you guys. Even though I have never seen a baby have resp. issues after cup feeding, I hate it. 1) It is a pain in the butt. 2) I don't think nipple confusion actually exists, esp. not if baby is BFing well. Our management won't let us bottlefeed a breast baby unless mom specifically asks. I am with you on the rant. I have nothing against lactation consultants per se, but we have several at our hospital that are like the Nipple Gestapo. Most of my Hispanic mothers breast and bottle their kids with absolutely no problem. Hate cupping!!!

Nipple confusion does exist. I tried to breast feed my baby in the hospital and he wouldn't eat. The nurses kept bothering me and making me nervous and asking if he had breastfed yet. It was really making me angry because they were feeding him formula behind my back and so he was never hungry. Because of this it took me about a week and a half to get breastfeesing my son fully established.

[BittyBabyGrower, MSN, RN]

navynurse...I'm sorry you had such a bad time, and yes, we have done syringe feedings, but I wouldn't just assume that none of us have or know other ways to feed kids. If your baby wasn't feeding well, the nursery should have had you pump after trying to feed and then let you give it to him however you saw fit. As for nipple confusion...I have seen lots of kids go back and forth with no problem, but there are some that prefer breast over bottle.

We have seen kids have a hard time after cup feeding...you pour it in and sometimes it goes down the wrong way. Same with fingerfeeds...if they can't get the plunger on the syringe to go down, we stop and either gavage or give a bottle.

[newbiern2006]

quite frankly, i don't understand the whole blood sugar issue in the first place - i've known some homebirth midwives for years, and none of them ever test a newborn's blood sugar, and none of those babies have suffered any harm (actually, their record as far as infant and maternal mortality and morbidity is better than hospitals', even in "high risk" populations). their moms just keep on breastfeeding them until their milk comes in, and that's that. our grandmothers did it that way, and none of our parents died of "low blood sugar." why do doctors think they need to mess with nature?

[prmenrs, RN]

You should be pouring it in; the technique I learned is to sit them up as much as possible-use your forearm to support the baby while you bend the head forward. @ the same time you tip the cup against their mouth. They either put their tongue outside the medicine cup and suck, or they put their tongue inside the cup and sort of lap it in (I never could get the second way to work, but the 1st worked great.

For syringe feeding, you can put the syringe tip directly in their mouth and gradually squeeze it in, or you can tape a feeding tube to your [gloved] finger, hold the syringe in the other hand and let him suck on your finger, gradually squeezing it in. If he won't suck, don't force him.

[Spidey's mom, ADN, BSN, RN]

I'm a major believer in breastfeeding - my 5 year old was weaned at 3 1/2 years.

However, I'm not a big believer in "nipple confusion". Especially with newborns.

Feeding a newborn formula alot and not allowing breastfeeding to get a good start is not right - sorry that happened to you navyscrubs - your baby was full when you tried to breastfeed and that was frustrating.

Colostrum is HIGH in carbs, protein, antibodies and low in fat . . . precisely what newborns need and so I don't understand NOT allowing babies to suck to their heart's content prior to "milk" coming in (colostrum is a form of milk btw).

steph

[TiffyRN, BSN, PhD]

What is the caloric content of colostrum? Because if it's too far off of 20cal/oz then the NICU's need to modify their feeding policies, many of our micropreemies do not need "high carb" feedings into their delicate undeveloped guts. Do the other NICU's have policies on changing the feeding if the babe is getting colostrum? Ours does not. I guess I don't buy that it's so rich that 2cc's of colostrum will raise blood sugar the same as 60cc's of 20cal/oz milk (be it EBM or formula).

Oh, and the reason we treat blood sugar so aggressively is (in my opinion) due to the abundant litigation. Try googling "neonatal hypoglycemia", or "newborn low blood sugar" and see how many lawyer's ads and websites you bring up.